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absite trauma2
| Question | Answer |
|---|---|
| worse oxygenation s/p CT plcmt--what could be problm? How dx? Tx | tracheobronchial injury; bronchoscopy; consider clamping tube |
| which side bronchial injury more common | right |
| mgmt penetrating injury anterior medial to mid axillary chest | need laparotomy or laparoscopy, among others to r/o diaphragm injury; may need other evaluation of box injuries depending on location |
| sternal fx should also be suspicious for | cardiac contusion--get ECG, CKMB |
| which rib fx highest risk for Ao transection | 1st, 2nd |
| mgmt gun shot abd | immed ex lap, even if stable |
| name 3 types of pelvic fx, mortality, transfusion requirement | type I=unstable/crush, >10U pRBCs mortality 25%; II=unstable, all thru 1side, 2-10U, mortality 10%; III=stable, 1-4U, mortality <5% |
| which type of pelvic fx has arterial bldg? venous bldg? | anterior pelvis=venous; posterior=arterial |
| if abd injury requiring ex lap and pelvic fx what do next | ex lap, then if pelvis still hemorrhaging can do pelvic packing, intraop external fixation then arteriography/embolization |
| mgmt of blunt injury pelvic hematoma | leave, unless expanding and pt unstable (then stabilize fx, pack pelvis and if in OR get angio/emboliz) |
| MC portion duo injured | 2nd (desc portion near ampulla of vater) |
| mgmt duo injuries, incl drains | most can be repaired primarily w debridement, but may need pyloric exclusion and gastrojejunostomy if big lesion; place feeding j tube and draining jejunosotmy tube threading it back to injury site |
| mgmt of fistula s/p duo injury | most close w time 4-6wk, give bowel rest, TPN, decompression, octreotide, and do fistulogram to r/o abscess. Consider distal obstruction |
| where are paraduo hematomas located, mgmt | usu 3rd portion duo overlying spine in blunt injury; open if in OR (can present w high SBO12-72 h s/p injury); most resolve w conservative mgmt 2-3wks |
| MC GI injury w penetrating injury | small bowel |
| how does occult small bowel injury look on CT, mgmt? | intra abd fluid w/o solid organ injury, bowel wall thickening, mesenteric hematoma; repeat 8-12h |
| mgmt small bowel injury | transverse repair to avoid stricture, if >50% circumference need resxn and re-anastomosis |
| mgmt small bowel hematoma | open if expanding or large (>2cm) |
| when can colon injuries be repaired primarily | R and transverse; if L need colostomy |
| mgmt colon hematomas | both penetrating and blunt need to be opened!! (unlike small bowel, duo or pelvic) |
| mgmt rectal trauma depending on site | high rectal extraperitoneal: drainage and fecal diversion w colostomy; intraperitoneal repair and colostomy; low rectal (<5cm) repair transanal |
| can c hepatic artery be ligated? Why | yes, collateral thru gastroduo |
| can hepatic lobar arteries be ligated? | no, causes liver isch |
| what is Pringle maneuver | clamping portal triad, doesn't stop bleeding from hep veins, can only do for 10-15min |
| if retrohep IVC injury, how do you get to it? | use atriocaval shunt |
| mgmt portal triad hematomas | must be explored! (unlike duo, small bowel or pelvic) |
| mgmt of CBD injury | if <50% repair over stent, >50% do choledochojejunostomy…10% leak |
| how manage portal vein injury | must be repaired, may need to go thru pancreas to get |
| what does conservative mgmt of liver injury consist of, when is it considered a failure | bed rest, failed if unstable (HR>120, SBP<90, Hct<25) despite aggressive resuscitation (4U RBCs) -> go to OR |
| what does conservative mgmt of spleen injury consist of, when is it considered a failure | bed rest, failed if unstable (HR>120, SBP<90, Hct<25) despite aggressive resuscitation (2U RBCs) -> go to OR |
| what CT findings related to spleen and portal vein are indications to take to OR | active blush on CT, pseudoaneur |
| most pancreatic injury s/p trauma are blunt or penetrating? | penetrating |
| mgmt pancreatic contusion | place a drain and leave if stable |
| mgmt of distal pancreatic duct injury, pancreatic head injury that is not reparable | distal:distal pancreatectomy (can take 80%), head: place drain and may need Whipple eventually |
| mgmt pan duct injury | ERCP and stent |
| mgmt pan hematoma | need to be opened |
| if vascular injury >2cm in length, what do? | need saph vein graft from contralateral leg |
| if major signs vascular injury do what? Moderate? | major (active hemorr, expanding/pulsatile hematoma, distal isch, bruit) -> go OR to explore; if moderate (large stable hematoma, deficit of assoc nerve) -> go angio |
| if ABI<0.9 do what | angio |
| which vein injuries need repair | vena cava, femoral, popliteal, brachiocephalic, subclavian, axillary |
| when do fasciotomy | isch >4h |
| mgmt transected single artery calf | ligate |
| what pressure is compartment syndrome | >20 |
| order of progression s/s compartment syndrome | pain -> paresthesia -> anesthesia -> paralysis -> poikilothermia -> pulselessness |
| 3 MC injuries leading to compartment syndrome | supracondylar humeral fx, tibial fx, crush injuries; key is disruption of flow followed by restoration |
| how repair IVC--use of clamps? Get to posterior wall? | don't use clamps bc will tear; to get to posterior wall go thru anterior wall |
| how manage loss of pulse w long bone fx | immed reduction, if pulse doesn't return go to OR |
| what n deficit w ant shoulder dislocation | Axillary n (deltoid numb, can’t ABD to horiz) |
| what n deficit w prox humerus fx | Axillary n (deltoid numb, can’t ABD to horiz) |
| what deficit at risk post shoulder dislocation | axillary a |
| which injuries risk brachial a disruption | distal/supracondylar humerus & elbow dislocation |
| what deficit at risk distal radius | Median n (thumb fxn ABD, opposition), can’t flex fingers, “As for MEdian: Thumb’s up, all’s OK, flex’ng yr nail polish w carpal tunnel.” |
| ant hip dislocation risks injury | fem a |
| post hip dislocation risks injury | sciatic n (butt, thigh) |
| popliteal a at risk when | distal femur and post knee dislocation |
| fibula neck fx risks injury… | c peroneal n (foot drop, anteriolat sensation leg) |
| what is best indicator renal trauma; next w/u | hematuria; CT (can use IVP if going to OR immed) |
| which renal artery/vein can be ligated safely, why? | L renal v can be ligated near IVC (adrenal and gonadal collaterals) |
| what's the order of renal hilum structures | vein, artery then pelvis from anterior to posterior |
| when surgery for renal trauma, incl acute v later | acutely: ongoign hemorr w instability; later if major collecting system disruption, unresolving urine extravasation, severe hematuria |
| penetrating renal injury w hematoma-what to do? | open, unless CT/IVP shows good fxn w/o significant urine extravasation |
| trauma to flank and IVP w/p uptake-do what? | angiogram, and can maybe stent |
| what best indicator of bladder trauma | hematuria |
| large majority bladder injury assoc w what | pelvic fx |
| dx bladder injury | cystogram |
| mgmt extraperitoneal bladder rx | foley 7-14d and usu resolves |
| mgmt intraperitoneal bladder rx | operation and repair followed by foley |
| hematuria is not reliable for dx of what injury | ureter! Good for bladder and renal |
| w/u ureteral injury | IVP and retrograde urethrogram (RUG) |
| mgmt of ureteral injury if can't reanastomose (ie 2cm) | if unstable: perQ nephrostomy (tie off both ends of ureter); stable: trans-reteroureterostomy |
| mgmt ureteral injury in lower 1/3, large segment can't reanastomose | reimplant in bladder |
| mgmt ureteral injury small segment | 1ry repair over stent or reimplant if lower 1/3 |
| where is blood supply for ureter, upper 2/3 and lower 1/3 | upper blood supply is medial, lower is lateral |
| s/s urethral trauma | hematuria, blood at meatus best sign, also free floating prostate (assoc w pelvic fx) |
| blood at meatus-what to do | no foley, urethrogram best test |
| mgmt tear in urethra | suprapubic cystostomy and repair in 2-3mos bc high stricture and impotence rate |
| genital trauma usu involves what, tx? | fx in erectile bodies, need repair tunica and Buck's fascia |
| when do you need to leave drains | pancreatic, liver, biliary, urinary, duo |
Created by:
ehstephns
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